Indian pediatrics最新文献

{"title":"Practice Recommendations for Metabolic Dysfunction-Associated Steatotic Liver Disease by the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN).","authors":"Vikrant Sood, Seema Alam, Aabha Nagral, Anshu Srivastava, Aniket Deshmukh, Ashish Bavdekar, Bhaswati C Acharyya, S M Geetha, Girish Gupte, Ishitaa Bhatia, Kritika Tiwari, Lalit Bharadia, Malathi Sathiyasekaran, Prabhsaran Kaur, Rajeev Khanna, Rimjhim Shrivastava, Samriddhi Poyekar, Snehavardhan Pandey, Somashekara Hosaagrahara Ramakrishna, Upendra Kinjawadekar, Vibhor Borkar, Viswanathan M Sivaramakrishnan, Rohit Kohli, John Matthai, Anil Dhawan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Justification: </strong>There has been an alarming increase in metabolic dysfunction-associated steatotic liver disease (MASLD) and it is now the most common chronic liver disease worldwide, in both adult and pediatric populations. The lack of regional guidelines has hampered the formulation of national policies for prevention and management of MASLD in children. Therefore, we formulated recommendations for steatotic liver disease in children.</p><p><strong>Objectives: </strong>To review the existing literature on the burden and epidemiology of pediatric MASLD and formulate recommendations for diagnostic evaluation, prevention, and management strategies.</p><p><strong>Process: </strong>The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international stakeholders to participate in a consensus meeting held on April 20, 2024, in Mumbai, Maharashtra, India. Various aspects of pediatric steatotic liver disease were deliberated upon and a consensus document and recommendations were formulated after several rounds of discussion.</p><p><strong>Recommendations: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) should be used as the preferred term in place of non-alcoholic fatty liver disease (NAFLD). There is a high prevalence of steatotic liver disease (SLD) among Indian children and adolescents, especially those who are overweight or obese. This condition may be progressive in childhood and associated with increased morbidity and mortality in adulthood. Various lifestyle, dietary, and genetic factors may predispose individuals to MASLD, including an increased intake of calorie-dense processed foods, sweetened sugar beverages, excessive screen time, higher sedentary time and lack of moderate to vigorous physical activity. MASLD is usually asymptomatic or presents with mild, non-specific symptoms and therefore, a high degree of suspicion is required for early diagnosis. MASLD is usually associated with cardiometabolic factors (hypertension, insulin resistance/diabetes mellitus, and/or dyslipidemia) and secondary causes should be excluded in all cases, particularly in the presence of red flag signs. Screening for MASLD should be considered in all obese children (body mass index or BMI ≥95th percentile) and in all overweight children (BMI ≥ 85th and <95thpercentile) with additional risk factors, such as prediabetes/diabetes, dyslipidemia, positive family history of metabolic syndrome, obstructive sleep apnea, and hypopituitarism. Abdominal ultrasound in combination with alanine aminotransferase (ALT) levels should be used as a screening test for MASLD in Indian children as per the proposed algorithm. Diet (any hypocaloric diet) and exercise (aerobic, resistance, or a combination of both; moderate to high intensity; regular in frequency) remain the cornerstones of pediatric MASLD management. Pharmacotherapy and/or endoscopic/surgical techniques for obesity should be considered a","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"919-934"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensory Stimulation and Structured Play Therapy in Children With Severe Acute Malnutrition.","authors":"Praveen Kumar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"61 10","pages":"917-918"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infant Feeding and Rearing Practices: Foundation of Healthy Childhood.","authors":"Rajesh Kumar Meena, Dheeraj Shah","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"61 10","pages":"994-996"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioavailable Vitamin D Levels in Children With First Episode Nephrotic Syndrome: A Longitudinal Study.","authors":"Sai Charan V, Abhijeet Saha, Rachita Singh Dhull, Anita Nangia, Rajeev Goyal, Prajal Agarwal, Harish K Pemde","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the levels of serum bioavailable vitamin D in children presenting with first episode nephrotic syndrome (FENS) at diagnosis and after 4 weeks of standard steroid therapy while the child is in remission, and compare the same with age-sex matched healthy controls.</p><p><strong>Methods: </strong>We included children aged 1 month to 12 years presenting as FENS and estimated the serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D], parathormone, serum and urine vitamin D binding protein (VDBP) at diagnosis and after 4 weeks of standard steroid therapy while the child is in remission. We also included age-sex matched healthy controls for comparison. Bioavailable and free 25(OH)D were estimated at enrolment and at 4 weeks of therapy.</p><p><strong>Results: </strong>The mean (SD) 25(OH)D level (ng/mL) in children with FENS was 11.3 (6.1) at diagnosis and 13.6 (6.2) at 4 weeks follow-up, while the observed value in healthy controls was 16 (7) ng/mL. The median (IQR) serum VDBP level in FENS at enrolment was 223.0 (144, 305.5) µg/mL. There was significant correlation between serum VDBP and serum albumin levels (P = 0.04). At 4 weeks (remission), the median (IQR) VDBP levels increased to 554.5 (383, 644.75) µg/mL (P < 0.001). The median (IQR) free 25(OH)D levels (pg/mL) in children with FENS was 1.07 (0.8, 1.6) at enrolment and 0.53 (0.37, 0.86) at 4 weeks follow-up. The median (IQR) bioavailable vitamin D in FENS during proteinuria was 0.58 (0.4, 0.83) ng/ml, much lower as compared to controls 0.97 (0.85, 1.08) ng/mL (P < 0.001). On follow-up at 4 weeks of remission the median (IQR) bioavailable vitamin D levels increased to 0.87 (0.59, 1.42) ng/mL (P = 0.015). There was a very strong positive correlation between free vitamin D and bioavailable vitamin D (r = 0.9, P < 0.001); a strong negative correlation between serum VDBP and bioavailable vitamin D (r = - 0.69, P < 0.001). There was a positive correlation between 25 (OH)D and bioavailable vitamin D (r = 0.63, P < 0.001). Serum VDBP and serum albumin showed statistically significant positive correlation (r = 0.37, P < 0.05).</p><p><strong>Conclusion: </strong>Children with FENS are deficient in vitamin D. The free and bioavailable vitamin D levels are reduced in children with FENS during the proteinuric phase. Further studies to assess the association between bioavailable vitamin D and 25(OH)D with bone mineral density are needed in children with nephrotic syndrome to validate the utility of bioavailable vitamin D in clinical practice.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"941-946"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing Coverage of Second Booster Dose of DPT Vaccine Coverage With Parental Education: A Cluster Randomized Approach.","authors":"Rangasai Anirudh Neeli, Amit Kumar Satapathy, Arvind Kumar Singh, Bhagirathi Dwibedi","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of a single clinic-based educational intervention session on parents of children aged 4.5 to 5.5 years on improving the coverage of a second booster dose of the DPT vaccine. The secondary objective was to assess the coverage of second booster dose of the DPT vaccine among children aged > 6 years and to learn about the reasons behind such dropouts, if any.</p><p><strong>Methods: </strong>The study was conducted in two phases. In the first phase, a cross-sectional study was conducted among children aged > 6 years who were attending the pediatric OPD or IPD to determine the coverage of the second booster dose of DPT vaccine and possible reasons for dropout.   This was followed by a clustered randomized trial evaluating the effect of an educational intervention (clinic-based, single session) among parents of children aged 4.5 to 5.5 years for improving second DPT booster coverage.</p><p><strong>Results: </strong>A total of 384 children were enrolled in the first phase, of which 233 (60.68%) were vaccinated. Subgroup analysis showed significant differences in the vaccine coverage between children from tribal-dominant and non-tribal-dominant districts (45.10% vs 63.06%, P = 0.01). Educational intervention resulted in higher vaccination coverage (77.24%) compared to 71.43% in the control arm (P = 0.300).</p><p><strong>Conclusion: </strong>The current study showed low coverage for second booster of DPT vaccine. With educational intervention, the target immunization coverage could be attained early which has implications for reducing childhood morbidity due to vaccine-preventable diseases.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"953-959"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAR T-Cell Therapy: A Promising Modality for Autoimmune Diseases.","authors":"Deepshi Thakral, Tejas Ramanan, Narendra Kumar Bagri","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chimeric Antigen Receptor (CAR) T-cells have emerged as a promising immune effector cell-based therapy. With promising results and approval for the treatment of hematological malignancies, we discuss the scope of this novel therapeutic modality in systemic autoimmune diseases and immune-mediated inflammatory disorders refractory to conventional and biological disease-modifying agents.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"983-986"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Dietary Recommendations in Children With Type 1 Diabetes: A Cross- Sectional Study.","authors":"Krishanu Kundu, Preeti Singh, Anju Seth","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Medical nutrition therapy is an essential component of management of type 1 diabetes (T1D). This study evaluated adherence of children with T1D to ISPAD 2018dietary recommendations.</p><p><strong>Methods: </strong>Dietary assessmentconducted for 75 children with T1D of duration > 1-year.</p><p><strong>Results: </strong>Adherence to the recommendations was observed in 40% of participants. Mean (SD) % calorie intake from carbohydrate, fat and protein was 51.93 (6.08), 32.42 (5.66) and 15.95 (2.45), respectively. 68% participants had an energy deficit of >10% of the estimated average requirement. Children in \"Adherent\" group had significantly lower energy intake from carbohydrates [50.26 (2.11) % vs. 53.18(7.39) %], saturated fats (<10%) and higher from proteins [16.74 (1.68) % vs. 15.42 (2.75) %] as compared to \"Non-adherent\" group (p <0.05). The mean (SD) HbA1c (%) was significantly lower in the \"Adherent\" group [7.5 (0.50) vs 9.17 (1.12)].</p><p><strong>Conclusion: </strong>Diet inlarge proportion of Indian children with T1D doesn't meetthe ISPAD recommendations.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"978-982"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MPox: An Evolving Threat and the Path Forward.","authors":"G V Basavaraja","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"61 10","pages":"913-914"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pachyonychia Congenita: A Rare Disorder of Keratinization.","authors":"Tavneet Kaur Makkar, Sonia Agrawal, Chander Grover","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"61 10","pages":"1001"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D and the Free Hormone Hypothesis.","authors":"Sushmita Banerjee, Rajiv Sinha","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"61 10","pages":"915-916"},"PeriodicalIF":1.7,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}